Date of last review: Due to be updated

Differential diagnosis

  • Non-functioning pituitary tumour
  • Macroprolactinoma
  • Acromegaly
  • Meningioma

Possible management by Optometrist

Treatment

  • None

Advice

  • Advise GP to check
    • Prolactin (prolactinomas can be treated medically)
    • LH, FSH, oestradiol (women), testosterone (men)
    • 9am cortisol, 9am glc
    • TSH, FT3, FT4
    • IGF-1, if symptoms suggestive of acromegaly
  • If vision affected, likely to return to normal with treatment, even if affected for some time

Management Category

  • Semi-urgent referral with visual fields to ophthalmology

Possible management by Ophthalmologist

  • Endocrine profile
    • Check for hormone over production
    • Check for hypopituitarism
  • Neuroimaging
  • Referral to endocrinology for macroprolactinomas
  • Referral to neurosurgery and endocrinology for all other causes